Evidence Table 1 Nerve Dysfunction After Distal Radius Fracture Reduction Included and Excluded Articles

Transcription

1 Author Henry, et al Dyer, et al. Bienek, et al Fuller, et al Odumala, et al Zoubos, et al Hove, et al Dresing, et al Evidence Table 1 Nerve Dysfunction After Distal Radius Fracture Reduction Included and Excluded Articles Title A prospective plan to minimise median nerve related complications associated with operatively treated distal radius fractures Predictors of acute carpal tunnel syndrome associated with fracture of the distal radius Peripheral nerve compression neuropathy after fractures of the distal radius Carpal canal pressures after volar plating of distal radius fractures Prophylactic carpal tunnel decompression during buttress plating of the distal radius--is it justified? Surgical treatment of 35 volar Barton fractures. No need for routine decompression of the median nerve Nerve entrapment and reflex sympathetic dystrophy after fractures of the distal radius Compartment pressure in the carpal tunnel in distal fractures of the radius. A prospective study Included or Reason for Exclusion Does not report patient oriented outcomes Patients do not have nerve dysfunction after reduction Patients do not have nerve dysfunction after reduction Patients do not have nerve dysfunction after reduction Patients do not have nerve dysfunction after reduction Patients do not have nerve dysfunction after reduction Patients do not have nerve dysfunction after reduction

2 Evidence Table 2 Nerve Dysfunction After Distal Radius Fracture Reduction Quality and Design of Prospective Non-Randomized Controlled Studies Author Outcome Duration N Comparison(s) Henry, et al Henry, et al Carpal Tunnel Syndrome Neuropathic Pain Syndrome Weeks Weeks MND w/ CTR vs. No MND, no CTR MND w/ CTR vs. No MND, no CTR All groups have similar characteristics at entry All groups have similar outcome performance at entry All groups concurrently treated Follow Up - 80% or more Same center for expiremental and control group data Crossover - equal experimental group results Crossover - equal control group results = Yes = No = Not Reported n/a = not applicable

3 Evidence Table 3 Nerve Dysfunction After Distal Radius Fracture Reduction Prospective Non-Randomized Controlled Studies DATA Author Outcome Duration N Treatment(s) Result Henry, et al Carpal Tunnel Syndrome Weeks 93 MND with CTR (Agee) 0% 0/93 patients Henry, et al Carpal Tunnel Syndrome Weeks 76 MND with CTR (FCR sheath release of TCL) 0% 0/76 patients Henry, et al Carpal Tunnel Syndrome Weeks 205 No MND, no CTR 0% 0/205 patients Henry, et al Neuropathic Pain Syndrome Weeks 93 MND with CTR (Agee) 0% 0/93 patients Henry, et al Neuropathic Pain Syndrome Weeks 76 MND with CTR (FCR sheath release of TCL) 0% 0/76 patients Henry, et al Neuropathic Pain Syndrome Weeks 205 No MND, no CTR 0% 0/205 patients

4 Evidence Table 4 Treatment of Adequately Reduced and Maintained Unstable Distal Radius Fracture Included and Excluded Articles Author Title No studies were identified by the literature search Included or Reason for Exclusion

5 Author Evidence Table 5 Operative vs. Non-operative Treatment of Unstable Distal Radius Fractures Included and Excluded Articles Title Included or Reason for Exclusion Young, et al McQueen, et al Abbaszadegan, et al Howard, et al Pring, et al Abramo, et al. Kreder, et al Zheng, et al Christensen, et al Kapoor, et al. Gupta, et al Lagerstrom, et al Stoffelen, et al Stoffelen, et al Stoffelen, et al Seven-year outcome following Colles' type distal radial fracture. A comparison of two treatment methods Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment External fixation of plaster cast for severely displaced Colles' fractures? Prospective 1-year study of 46 patients External fixation or plaster for severely displaced comminuted Colles' fractures? A prospective study of anatomical and functional results Bipolar fixation of fractures of the distal end of the radius: a comparative study Evaluation of a treatment protocol in distal radius fractures: a prospective study in 581 patients using DASH as outcome A randomized, controlled trial of distal radius fractures with metaphyseal displacement but without joint incongruity: closed reduction and casting versus closed reduction, spanning external fixation, and optional percutaneous K-wires A comparison of conservative and surgical treatment of distal radius unstable fracture Plaster cast compared with bridging external fixation for distal radius fractures of the Colles' type Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation Colles' fracture: management by percutaneous crossed-pin fixation versus plaster of Paris cast immobilization Recovery of isometric grip strength after Colles' fracture: a prospective two-year study Closed reduction versus Kapandji-pinning for extra-articular distal radial fractures Conservative treatment versus Kapandji-pinning for extra-articular distal radius fractures Kapandji pinning or closed reduction for extra-articular distal radius fractures Enrolls only stable fractures Reports complications only, < 25 patients Reports complications only, < 25 patients Severity of injury not defined Patient oriented outcomes compare gender not intervention Duplicate study Cannot locate publication Severity of injury not defined

6 Author Evidence Table 5 Operative vs. Non-operative Treatment of Unstable Distal Radius Fractures Included and Excluded Articles Title Included or Reason for Exclusion Cohen, et al Rodriguez-Merchan, et al vandijk, et al Merchan, et al Shankar, et al Stein, et al Kongsholm, et al Solgaard, et al Solgaard, et al Boyd, et al Jenkins, et al Kaukonen, et al Schmalholz, et al Jenkins, et al Distal radius fractures: a prospective randomized comparison of fibreglass tape with QuickCast Plaster cast versus percutaneous pin fixation for comminuted fractures of the distal radius in patients between 46 and 65 years of age Dynamic external fixation versus non-operative treatment of severe distal radial fractures Plaster cast versus Clyburn external fixation for fractures of the distal radius in patients under 45 years of age Comminuted Colles' fractures: a prospective trial of management Cast or external fixation for fracture of the distal radius. A prospective study of 126 cases Plaster cast versus external fixation for unstable intraarticular Colles' fractures External fixation or a cast for Colles' fracture Displaced distal radius fractures. A comparative study of early results following external fixation, functional bracing in supination, or dorsal plaster immobilization The outcome of fractures of the distal radius in young adults External fixation and recovery of function following fractures of the distal radius in young adults Functional recovery after fractures of the distal forearm. Analysis of radiographic and other factors affecting the outcome A scintimetric study of Colles' fracture. Comparison between cementation and closed treatment External fixation of Colles' fractures. An anatomical study Reports complications only, < 25 patients Reports complications only, < 25 patients Severity of injury not reported Reports complications only, < 25 patients Reports complications only, < 25 patients Does not report patient oriented outcomes Does not report patient oriented outcomes Reports complications only, < 25 patients

7 Evidence Table 6 Operative vs. Non-operative Treatment of Unstable Distal Radius Fractures Quality and Design of Randomized Controlled Trials Author Outcome Duration N Treatment(s) Young, et al McQueen, et al Abbaszadegan, et al Abbaszadegan, et al Abbaszadegan, et al Abbaszadegan, et al Abbaszadegan, et al Abbaszadegan, et al Abbaszadegan, et al Abbaszadegan, et al Howard, et al Pring, et al = Yes = No = Not Reported n/a = not applicable Pain free 7 Years 85 Complications n/a 109 Function - VAS 8 Weeks 46 Pain - VAS 8 Weeks 46 Function - VAS 12 Weeks 46 Pain - VAS 12 Weeks 46 Function - VAS 24 Weeks 46 Pain - VAS 24 Weeks 46 Function - VAS 1 Year 46 Pain - VAS 1 Year 46 Complications n/a 50 Complications n/a 67 Cast Cast Cast Cast Cast Cast Cast Cast Cast Cast Cast Cast Bipolar fixation vs. Stochastic Randomization Allocation Concealment Patients Blinded Those rating outcome Blinded Follow Up - 80% or more All groups have similar outcome performance at entry Crossover - equal experimental group results Crossover - equal control group results

8 Evidence Table 7 Operative vs. Non-operative Treatment of Unstable Distal Radius Fractures Randomized Controlled Studies DATA Author Outcome Duration N Treatment(s) Operative Non-operative Young, et al Pain free 7 Years 85 Abbaszadegan, et al Function - VAS 8 Weeks 46 Abbaszadegan, et al Function - VAS 12 Weeks 46 Abbaszadegan, et al Function - VAS 24 Weeks 46 Abbaszadegan, et al Function - VAS 1 Year 46 Abbaszadegan, et al Pain - VAS 8 Weeks 46 Abbaszadegan, et al Pain - VAS 12 Weeks 46 Abbaszadegan, et al Pain - VAS 24 Weeks 46 Abbaszadegan, et al Pain - VAS 1 Year 46 Cast Cast Cast Cast Cast Cast Cast Cast Cast : median score 0-10 where 10 is normal function (unit of measurement not reported); : median score 0-10 (unit of measurement not reported), * reported by author(s) 83% (30/36 patients) 7 (range: NR) p = 0.1* 7 (range: NR) p = 0.7* 9 (range: NR) p = 0.1* 10 (range: NR) p = 0.02* 2 (range: NR) p = 0.4* 1 (range: NR) p = 0.1* 0.5 (range: NR) p = 0.009* 0 (range: NR) p = 0.002* 79% (39/49 patients) 5 (range: NR) 7 (range: NR) 8 (range: NR) 9 (range: NR) 3 (range: NR) 2 (range: NR) 2 (range: NR) 1 (range: NR)

9 Author Krukhaug, et al Egol, et al. Leung, et al. vanmanen, et al. Kreder, et al. Harley, et al. Krishnan, et al Werber, et al Hahnloser, et al McQueen, et al Ludvigsen, et al Hutchinson, et al Pritchett, et al Raskin, et al Andersen, et al Figl, et al Evidence Table 8 Operative Treatments for Distal Radius Fractures Included and Excluded Articles Title External fixation of fractures of the distal radius: a randomized comparison of the Hoffman compact II nonbridging fixator and the Dynawrist fixator in 75 patients followed for 1 year Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial fractures. A randomized study Bio-resorbable versus metal implants in wrist fractures: a randomised trial Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intraarticular fractures of the distal radius: a randomised, controlled trial Augmented external fixation versus percutaneous pinning and casting for unstable fractures of the distal radius--a prospective randomized trial Intra-articular fractures of the distal radius: a prospective randomised controlled trial comparing static bridging and dynamic non-bridging external fixation External fixation of distal radial fractures: four compared with five pins: a randomized prospective study Internal fixation of distal radius fractures with dorsal dislocation: pi-plate or two 1/4 tube plates? A prospective randomized study Redisplaced unstable fractures of the distal radius. A randomised, prospective study of bridging versus non-bridging external fixation External fixation versus percutaneous pinning for unstable Colles' fracture. Equal outcome in a randomized study of 60 patients Pins and plaster vs external fixation in the treatment of unstable distal radial fractures. A randomized prospective study External fixation or closed medullary pinning for unstable Colles fractures? Unstable articular fractures of the distal radius. Comparative techniques of ligamentotaxis Colles' Fracture Treated with Non-Bridging External Fixation: A 1-Year Follow-Up Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results Included or Reason for Exclusion

10 Author Jupiter, et al Mirza, et al Othman, et al Wong, et al Abramo, et al. Adani, et al. Chen, et al. Chung, et al. Cooper, et al. Gerald, et al. Glickel, et al. Grala, et al. Hayes, et al. Ilyas, et al. Lattmann, et al. Lutsky, et al. Evidence Table 8 Operative Treatments for Distal Radius Fractures Included and Excluded Articles Title Operative management of distal radial fractures with 2.4-millimeter locking plates. A multicenter prospective case series Fractures of the distal radius treated with cross-pin fixation and a nonbridging external fixator, the CPX system: a preliminary report Fixation of dorsally displaced distal radius fractures with volar plate Palmar fixation of dorsally displaced distal radius fractures using locking plates with Smartlock locking screws Evaluation of a treatment protocol in distal radius fractures: a prospective study in 581 patients using DASH as outcome The treatment of distal radius articular fractures through lcp system Treatment of Distal Radius Fractures with Percutaneous Pinning and Pin-in-plaster Comparative outcomes study using the volar locking plating system for distal radius fractures in both young adults and adults older than 60 years A short term functional outcome study comparing closed reduction percutaneous wire fixation with open reduction internal fixation for fractures of the distal radius: A pilot study Volar plate fixation of AO type C2 and C3 distal radius fractures, a single-center study of 55 patients Long-term outcomes of closed reduction and percutaneous pinning for the treatment of distal radius fractures Hybrid external fixation for neglected fractures of the distal radius: results after one year Bridging and non-bridging external fixation in the treatment of unstable fractures of the distal radius: a retrospective study of 588 patients Intramedullary fixation of displaced distal radius fractures: a preliminary report Comparison of 2 surgical approaches for volar locking plate osteosynthesis of the distal radius Arthroscopic assessment of intra-articular distal radius fractures after open reduction and internal fixation from a volar approach Included or Reason for Exclusion Does not report patient oriented outcomes

11 Author Mehboob, et al. Osada, et al. Pieske, et al. Sammer, et al. Arora, et al Chang, et al Gerostathopoulos, et al Snow, et al Szyluk, et al Chung, et al Dai, et al Egol, et al Goldfarb, et al Gruber, et al Kamath, et al Lozano-Calderon, et al Evidence Table 8 Operative Treatments for Distal Radius Fractures Included and Excluded Articles Title Fixation of extra articular distal radial fractures with non bridging external fixator Prospective study of distal radius fractures treated with a volar locking plate system Titanium alloy pins versus stainless steel pins in external fixation at the wrist: a randomized prospective study A comparative study of fragment-specific versus volar plate fixation of distal radius fractures Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate Fragment-specific fracture fixation and double-column plating of unstable distal radial fractures using AO mini-fragment implants and Kirschner wires Trimed fixation system for displaced fractures of the distal radius Function Versus Position: A Randomized Controlled Trial of Interfocal Kirschner Wiring of Unstable Distal Radial Fractures Results of operative treatment of unstable distal radius fractures using percutaneous K wire fixation Treatment of unstable distal radial fractures with the volar locking plating system Treatment of volar Barton's fractures: comparison between two common surgical techniques Treatment of external fixation pins about the wrist: a prospective, randomized trial Fifteen-year outcome of displaced intra-articular fractures of the distal radius Surgical treatment of distal radius fractures with an angle fixed bar palmar plating system: a single center study of 102 patients over a 2-year period Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation Included or Reason for Exclusion Not relevant, not considered for this guideline Does not report patient oriented outcomes Not relevant, not considered for this guideline

12 Author Ruch, et al Simic, et al Suckel, et al Arora, et al. Gradl, et al. Grewal, et al. Khanduja, et al. Lutz, et al. Rikli, et al. Ruch, et al. Ruschel, et al. Westphal, et al. Wong, et al. Wright, et al. Aggarwal, et al. Evidence Table 8 Operative Treatments for Distal Radius Fractures Included and Excluded Articles Title Volar versus dorsal plating in the management of intra-articular distal radius fractures Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment Dorsal (AO/ASIF) pi-plate osteosynthesis in the treatment of distal intraarticular radius fractures External fixation in comminuted, displaced intra-articular fractures of the distal radius: is it sufficient? Fractures of the distal radius treated with a nonbridging external fixation technique using multiplanar k- wires A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation, and external fixation Complications and functional outcome following fixation of complex, intra-articular fractures of the distal radius with the AO Pi-Plate Sagittal wrist motion of carpal bones following intraarticular fractures of the distal radius Dorsal double-plate fixation of the distal radius Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution Treatment of unstable extra-articular distal radius fractures by modified intrafocal Kapandji method Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF Volar fixation of dorsally displaced distal radial fracture using locking compression plate Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation Open reduction and internal fixation of volar Barton's fractures: a prospective study Included or Reason for Exclusion Insufficient reporting of outcomes

13 Author Anand, et al. Hargreaves, et al. Krukhaug, et al. Prokop, et al. Ring, et al. Uchikura, et al. Zamzuri, et al. Gangopadhyay, et al Kamano, et al Letsch, et al Rikli, et al Rozental, et al DePK;Nijs, et al Konrath, et al Mehta, et al Orbay, et al Evidence Table 8 Operative Treatments for Distal Radius Fractures Included and Excluded Articles Title Role of dynamic external fixator in the management of fractures of distal end of radius Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried wires Experience with the AO Pi-plate for displaced intra-articular fractures of the distal radius Do angle stable implants provide advantages? Treatment of distal radius fractures with the locking compression plate (LCP) Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius Comparative study of nonbridging and bridging external fixators for unstable distal radius fractures External fixation versus internal fixation for closed unstable intra-articular fracture of the distal radius. Early results from a prospective study A comparative study between longitudinal and 'T' incisions for dorsal plating of the distal radius Palmar Plating with Calcium Phosphate Bone Cement for Unstable Colles' Fractures Surgical treatment of fractures of the distal radius with plates: a comparison of palmar and dorsal plate position Complex fractures of the distal radius Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius The 'Clip U2', a new device in treating distal radial fractures Open reduction and internal fixation of unstable distal radius fractures: results using the trimed fixation system Local osteopenia associated with management of intra-articular distal radial fractures by insertion of external fixation pins in the distal fragment: prospective study Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report Included or Reason for Exclusion Does not report patient oriented outcomes Retrospective case series

14 Author Rosenthal, et al Rozental, et al Sato, et al Rogachefsky, et al Schneeberger, et al Auge, et al. Haddad, et al. Hede, et al. Jakob, et al. Kaempffe, et al. Kapoor, et al. Klein, et al. McKenna, et al. Brady, et al Fritz, et al Goslings, et al Evidence Table 8 Operative Treatments for Distal Radius Fractures Included and Excluded Articles Title Intrafocal pinning of distal radius fractures: a simplified approach Open fractures of the distal radius Antegrade intramedullary K-wire fixation for distal radial fractures Treatment of severely comminuted intra-articular fractures of the distal end of the radius by open reduction and combined internal and external fixation Open reduction and plate fixation of displaced AO type C3 fractures of the distal radius: restoration of articular congruity in eighteen cases The application of indirect reduction techniques in the distal radius: the role of adjuvant arthroscopy External fixation of distal radial fractures: 3 or 5 weeks of external fixation Comparison of intramedullary fixation and percutaneous pinning of displaced and comminuted Colles' fractures: a prospective and consecutive study Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients External fixation for distal radius fractures: effect of distraction on outcome Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation Results of transarticular fixator application in distal radius fractures External fixation of distal radial fractures The unstable distal radial fracture one year post Kapandji intrafocal pinning Combined Kirschner wire fixation in the treatment of Colles fracture. A prospective, controlled trial Three-dimensional dynamic external fixation of distal radial fractures. A prospective study Included or Reason for Exclusion Reports complications only, < 25 patients

15 Author Carter, et al Kawaguchi, et al Trumble, et al Cannegieter, et al Catalano, et al Fitoussi, et al Hove, et al Hove, et al Ponziani, et al Putnam, et al Ring, et al Zanotti, et al Zoubos, et al Dowdy, et al Lenoble, et al Agee, et al Evidence Table 8 Operative Treatments for Distal Radius Fractures Included and Excluded Articles Title Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures Recurrent dorsal angulation of the distal radius fracture during dynamic external fixation Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation Cancellous grafting and external fixation for unstable Colles' fractures Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation Treatment of displaced intra-articular fractures of the distal end of the radius with plates Closed reduction and external fixation of unstable fractures of the distal radius Open reduction and internal fixation of displaced intraarticular fractures of the distal radius. 31 patients followed for 3-7 years The external fixator for the treatment of wrist fractures Treatment of unstable distal radius fractures: methods and comparison of external distraction and ORIF versus external distraction-orif neutralization Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures Intra-articular fractures of the distal end of the radius treated with an adjustable fixator system Surgical treatment of 35 volar Barton fractures. No need for routine decompression of the median nerve Intrafocal (Kapandji) pinning of unstable distal radius fractures: a preliminary report Fracture of the distal radius. A prospective comparison between trans-styloid and Kapandji fixations Treatment of comminuted distal radius fractures: an approach based on pathomechanics Included or Reason for Exclusion

16 Author Habernek, et al Keating, et al Sommerkamp, et al Steffen, et al Trumble, et al Eglseder, et al Kaempffe, et al Suso, et al Tsukazaki, et al Casteleyn, et al Field, et al Helm, et al Missakian, et al Altissimi, et al Geissler, et al Horesh, et al Evidence Table 8 Operative Treatments for Distal Radius Fractures Included and Excluded Articles Title Unstable distal radius fractures treated by modified Kirschner wire pinning: anatomic considerations, technique, and results Internal fixation of volar-displaced distal radial fractures Dynamic external fixation of unstable fractures of the distal part of the radius. A prospective, randomized comparison with static external fixation Twelve years follow-up of fractures of the distal radius treated with the AO external fixator Factors affecting functional outcome of displaced intra-articular distal radius fractures Open half-pin insertion for distal radial fractures Severe fractures of the distal radius: effect of amount and duration of external fixator distraction on outcome Comminuted intra-articular fractures of the distal end of the radius treated with the Hoffmann external fixator Ulnar wrist pain after Colles' fracture. 109 fractures followed for 4 years Biodegradable rods versus Kirschner wire fixation of wrist fractures. A randomised trial Long-term prognosis of displaced Colles' fracture: a 10-year prospective review The chauffeur's fracture: simple or complex? Open reduction and internal fixation for distal radius fractures Comminuted articular fractures of the distal radius. Results of conservative treatment Percutaneous and limited open reduction of the articular surface of the distal radius The surgical treatment of severe comminuted intraarticular fractures of the distal radius with the small AO external fixation device. A prospective three-and-one-half-year follow-up study Included or Reason for Exclusion Reports complications only, < 25 patients Does not report validated, patient oriented outcomes

17 Author Jakim, et al Strange-Vognsen, et al vanraay, et al Verhaven, et al Yen, et al vanleeuwen, et al Bennett, et al Bradway, et al Lennox, et al Rayhack, et al Smith, et al Clyburn, et al Lacroix, et al Peyroux, et al Foster, et al Knirk, et al Evidence Table 8 Operative Treatments for Distal Radius Fractures Included and Excluded Articles Title External fixation for intra-articular fractures of the distal radius Intraarticular fractures of the distal end of the radius in young adults. A 16 (2-26) year follow-up of 42 patients External fixation of Smith's fracture. 16 patients followed for 2 years External fixation for comminuted intra-articular wrist fractures A semiinvasive method for articular Colles' fractures Operative treatment of Smith-Goyrand fractures Intramedullary fixation of unstable distal radius fractures. A method of fixation allowing early motion Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius Use of the Clyburn External Fixator in fractures of the distal radius Transulnar percutaneous pinning of displaced distal radial fractures: a preliminary report Open reduction and internal fixation of volar lip fractures of the distal radius Dynamic external fixation for comminuted intra-articular fractures of the distal end of the radius Operative treatment of unstable distal radial fractures The Kapandji technique and its evolution in the treatment of fractures of the distal end of the radius. Report on a series of 159 cases Update on external fixators in the treatment of wrist fractures Intra-articular fractures of the distal end of the radius in young adults Included or Reason for Exclusion

18 Author Melone, et al Weber, et al Nakata, et al Vaughan, et al Bossi, et al Lucas, et al Marsh, et al Blichert-Toft, et al Evidence Table 8 Operative Treatments for Distal Radius Fractures Included and Excluded Articles Title Open treatment for displaced articular fractures of the distal radius Severely comminuted distal radial fracture as an unsolved problem: complications associated with external fixation and pins and plaster techniques External fixators for wrist fractures: a biomechanical and clinical study Treatment of unstable fractures of the distal radius by external fixation External fixation in the treatment of fractures of the distal forearm An analysis of hand function in patients with colles' fracture treated by Rush rod fixation Treatment of comminuted fractures of the distal radius with self-contained skeletal traction Colles' fracture treated with modified Bohler technique Included or Reason for Exclusion

19 Evidence Table 9 Operative Treatments for Distal Radius Fractures Quality and Design of Randomized Controlled Trials Author Outcome Duration N Treatment(s) Krukhaug, et al Egol, et al. Egol, et al. Egol, et al. Egol, et al. Egol, et al. Egol, et al. Leung, et al. Leung, et al. Leung, et al. vanmanen, et al. Kreder, et al. Kreder, et al. = Yes = No = Not Reported n/a = not applicable DASH 1 Year 71 DASH 3 Months 77 Pain - VAS 3 Months 77 DASH 6 Months 77 Pain - VAS 6 Months 77 DASH 1 Year 77 Pain - VAS 1 Year 77 Social activity (none- slight) Activities of daily living (none- slight) Normal work (none- slight) n/a 144 n/a 144 n/a 144 DASH 1 Year 32 SF-36 (bodily pain) n/a 118 MFA upper limb n/a 118 External fixation - non-bridging vs. External fixation - dynamic bridging Volar locking plate Volar locking plate Volar locking plate Volar locking plate Volar locking plate Volar locking plate Plate(s) Plate(s) Plate(s) Bio-resorbable plate vs. Metal plate Open reduction and internal fixation Open reduction and internal fixation External fixation - bridging and K wires vs. External fixation - bridging and K wires vs. External fixation - bridging and K wires vs. External fixation - bridging and K wires vs. External fixation - bridging and K wires vs. External fixation - bridging and K wires vs. External fixation - bridging and K-wires vs. External fixation - bridging and K-wires vs. External fixation - bridging and K-wires vs. Indirect reduction and percutaneous fixation vs. Indirect reduction and percutaneous fixation vs. Stochastic Randomization Allocation Concealment Patients Blinded Those rating outcome Blinded Follow Up - 80% or more All groups have similar outcome performance at entry Crossover - equal experimental group results Crossover - equal control group results

20 Evidence Table 9 Operative Treatments for Distal Radius Fractures Quality and Design of Randomized Controlled Trials = Yes = No = Not Reported n/a = not applicable Author Outcome Duration N Treatment(s) Harley, et al. Harley, et al. Harley, et al. Harley, et al. Harley, et al. Harley, et al. Krishnan, et al Krishnan, et al Werber, et al DASH 6 Months 41 SF-36 (physical) 6 Months 41 SF-36 (mental) 6 Months 41 DASH 12 Months 33 SF-36 (physical) 12 Months 33 SF-36 (mental) 12 Months 33 Pain - VAS 6 Weeks 60 Pain - VAS 26 Weeks 60 Complications n/a 50 Augmented external fixation - bridging vs. Stochastic Randomization Allocation Concealment Patients Blinded Those rating outcome Blinded Follow Up - 80% or more All groups have similar outcome performance at entry Percutaneous pinning Percutaneous pinning Percutaneous pinning Percutaneous pinning Percutaneous pinning Percutaneous pinning External fixation - non-bridging External fixation - non-bridging External fixation - five pins, bridging Augmented external fixation - bridging vs. Augmented external fixation - bridging vs. Augmented external fixation - bridging vs. Augmented external fixation - bridging vs. Augmented external fixation - bridging vs. External fixation - four pins, bridging vs. Crossover - equal experimental group results Crossover - equal control group results

21 Evidence Table 9 Operative Treatments for Distal Radius Fractures Quality and Design of Randomized Controlled Trials = Yes = No = Not Reported n/a = not applicable Author Outcome Duration N Treatment(s) Hahnloser, et al Hahnloser, et al Hahnloser, et al Hahnloser, et al Hahnloser, et al McQueen, et al McQueen, et al McQueen, et al McQueen, et al Ludvigsen, et al Hutchinson, et al Pritchett, et al Raskin, et al Pain - VAS (none) n/a 46 Activities of daily living n/a 46 Pain - VAS (mild, 0-3) n/a 46 Pain - VAS (moderate, 4-7) n/a 46 Pain - VAS (severe, 8-10) n/a 46 Pain 1 Year 56 Pain - VAS 1 Year 56 Pain, DRUJ 1 Year 56 Pain, carpal 1 Year 56 Complications n/a 60 Complications n/a 85 Complications n/a 100 Activities of daily living Final Followup 60 Stochastic Randomization Allocation Concealment Patients Blinded Those rating outcome Blinded Follow Up - 80% or more All groups have similar outcome performance at entry Dorsal plate vs. Two 1/4 tube plates Dorsal plate vs. Two 1/4 tube plates Dorsal plate vs. Two 1/4 tube plates Dorsal plate vs. Two 1/4 tube plates Dorsal plate vs. Two 1/4 tube plates External fixation - non-bridging External fixation - non-bridging External fixation - non-bridging External fixation - non-bridging Percutaneous pinning vs. External fixation - bridging Pins and plaster vs. External fixation - bridging Medullary pinning Pins and Plaster vs. External fixation - bridging Crossover - equal experimental group results Crossover - equal control group results

22 Author Outcome Duration N Evidence Table 10 Operative Treatments for Distal Radius Fractures Randomized Controlled Studies DATA Treatment(s) Group I is listed first, Group II is listed second Group I Group II Krukhaug, et al DASH 1 Year 71 Egol, et al. Pain - VAS 3 Months 77 Egol, et al. Pain - VAS 6 Months 77 Egol, et al. Pain - VAS 1 Year 77 Egol, et al. Egol, et al. Egol, et al. Leung, et al. Leung, et al. Leung, et al. vanmanen, et al. Kreder, et al. Kreder, et al. DASH 3 Months 77 DASH 6 Months 77 DASH 1 Year 77 Activities of daily living (none- slight) Social activity (none- slight) Normal work (none- slight) n/a 144 n/a 144 n/a 144 DASH 1 Year 32 MFA upper limb n/a 118 SF-36 (bodily pain) n/a 118 Krishnan, et al Pain - VAS 6 Weeks 60 Krishnan, et al Pain - VAS 26 Weeks 60 External fixation - non-bridging vs. External fixation - dynamic bridging External fixation - bridging and K wires vs. Volar locking plate External fixation - bridging and K wires vs. Volar locking plate External fixation - bridging and K wires vs. Volar locking plate External fixation - bridging and K wires vs. Volar locking plate External fixation - bridging and K wires vs. Volar locking plate External fixation - bridging and K wires vs. Volar locking plate External fixation - bridging and K-wires vs. Plate(s) External fixation - bridging and K-wires vs. Plate(s) External fixation - bridging and K-wires vs. Plate(s) Bio-resorbable plate vs. Metal plate Indirect reduction and percutaneous fixation vs. Open reduction and internal fixation Indirect reduction and percutaneous fixation vs. Open reduction and internal fixation External fixation - non-bridging External fixation - non-bridging 9 (95% CI: 3, 14) 13 (95% CI: 8, 20) 1.8 ± ± ± ± ± ± ± ± ± ± ± ± % (64/74 patients) 76% (56/74 patients) 76% (56/74 patients) 92% (64/70 patients) 81% (57/70 patients) 84% (59/70 patients) ± ± (95% CI: -33.0, -4.1) ANOVA favors Group I (95% CI: -0.1, 1.5) ANOVA not statistically significant 0.9 (Range: NR) p = ns 0 (Range: NR) p = ns 1.4 (Range: NR) 0 (Range: NR) : mean score 0-10 where 10 is severe pain, measured in mm; : median score 0-10 (unit of measurement not reported), *reported by author(s)

23 Author Outcome Duration N Evidence Table 10 Operative Treatments for Distal Radius Fractures Randomized Controlled Studies DATA Treatment(s) Group I is listed first, Group II is listed second Group I Group II Harley, et al. DASH 6 Months 41 Augmented external fixation - bridging vs. Percutaneous pinning 22 ± ± 22 Harley, et al. DASH 12 Months 33 Augmented external fixation - bridging vs. Percutaneous pinning 23 ± ± 18 Harley, et al. SF-36 (mental) 6 Months 41 Augmented external fixation - bridging vs. Percutaneous pinning 51 ± ± 8 Harley, et al. SF-36 (mental) 12 Months 33 Augmented external fixation - bridging vs. Percutaneous pinning 52 ± ± 8 Harley, et al. SF-36 (physical) 6 Months 41 Augmented external fixation - bridging vs. Percutaneous pinning 48 ± 7 46 ± 11 Harley, et al. SF-36 (physical) 12 Months 33 Augmented external fixation - bridging vs. Percutaneous pinning 45 ± ± 11 Hahnloser, et al Activities of daily living n/a 46 Dorsal plate vs. Two 1/4 tube plates 66.7% (14/21 patients) 80% (20/25 patients) Hahnloser, et al Pain - VAS (none) n/a 46 Dorsal plate vs. Two 1/4 tube plates 33% (7/21 patients) 44% (11/25 patients) Hahnloser, et al Pain - VAS (mild, 0-3) n/a 46 Dorsal plate vs. Two 1/4 tube plates 57% (12/21 patients) 44% (11/25 patients) Hahnloser, et al Pain - VAS (moderate, 4-7) n/a 46 Dorsal plate vs. Two 1/4 tube plates 5% (1/21 patients) 12% (3/25 patients) Hahnloser, et al Pain - VAS (severe, 8-10) n/a 46 Dorsal plate vs. Two 1/4 tube plates 5% (1/21 patients) 0% (0/25 patients) McQueen, et al Pain - VAS* 1 Year 56 External fixation - non-bridging 1.3 ± NR 1.2 ± NR p = ns* McQueen, et al Pain 1 Year 56 External fixation - non-bridging 57% (16/28 patients) 50% (14/28 patients) McQueen, et al Pain, DRUJ 1 Year 56 External fixation - non-bridging 29% (8/28 patients) 25% (7/28 patients) McQueen, et al Pain, carpal 1 Year 56 External fixation - non-bridging 25% (7/28 patients) 11% (3/28 patients) Raskin, et al Activities of daily living Final Followup 60 Pins and Plaster vs. External fixation - bridging 100% (30/30 patients) 100% (30/30 patients) *: mean score 0-10 (unit of measurement not reported), *reported by author(s)

24 Evidence Table 11 Operative vs. Non-operative Treatment of Distal Radius Fractures in Patients Over Age 55 Included and Excluded Articles Author Title Included or Reason for Exclusion Azzopardi, et al. Hegeman, et al. Roumen, et al Arora, et al Synn, et al Abramo, et al. Moroni, et al. Board, et al Horne, et al Unstable extra-articular fractures of the distal radius: a prospective, randomised study of immobilisation in a cast versus supplementary percutaneous pinning Primary external fixation versus plaster immobilization of the intra-articular unstable distal radial fracture in the elderly Unstable Colles' fractures in elderly patients. A randomised trial of external fixation for redisplacement A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating Distal radius fractures in older patients: is anatomic reduction necessary? Evaluation of a treatment protocol in distal radius fractures: a prospective study in 581 patients using DASH as outcome Cast vs external fixation: a comparative study in elderly osteoporotic distal radial fracture patients Does Kapandji wiring help in older patients? A retrospective comparative review of displaced intra-articular distal radial fractures in patients over 55 years A prospective randomized trial of external fixation and plaster cast immobilization in the treatment of distal radial fractures Combines casting and operative results Insufficient data Reports complications only, < 25 patients Reports complications only, < 25 patients

25 Evidence Table 12 Operative vs. Non-operative Treatment of Distal Radius Fractures in Patients Over Age 55 Quality and Design of Randomized Controlled Trials Author Outcome Duration N Treatment(s) Azzopardi, et al. Azzopardi, et al. Azzopardi, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. = Yes = No = Not Reported n/a = not applicable Pain - VAS 1 Year 57 SF-36 (mental) 1 Year 57 SF-36 (physical) 1 Year 57 Function - difficulty lifting cup 6 Weeks 32 Function - difficulty w/ fine hand coordination Function - difficulty w/ heavy load bearing 6 Weeks 32 6 Weeks 32 Function - difficulty wringing 6 Weeks 32 Pain, radiocarpal 6 Weeks 32 Pain, radioulnar 6 Weeks 32 Pain, ulnocarpal 6 Weeks 32 Percutaneous pinning vs. Cast Cast Cast Cast Cast Cast Cast Cast Cast Cast Percutaneous pinning vs. Percutaneous pinning vs. Stochastic Randomization Allocation Concealment Patients Blinded Those rating outcome Blinded Follow Up - 80% or more All groups have similar outcome performance at entry Crossover - equal experimental group results Crossover - equal control group results

26 Evidence Table 12 Operative vs. Non-operative Treatment of Distal Radius Fractures in Patients Over Age 55 Quality and Design of Randomized Controlled Trials = Yes = No = Not Reported n/a = not applicable Author Outcome Duration N Treatment(s) Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Function - difficulty lifting cup 3 Months 32 Function - difficulty w/ fine hand coordination Function - difficulty w/ heavy load bearing 3 Months 32 3 Months 32 Function - difficulty wringing 3 Months 32 Pain, radiocarpal 3 Months 32 Pain, radioulnar 3 Months 32 Pain, ulnocarpal 3 Months 32 Function - difficulty lifting cup 1 Year 32 Function - difficulty w/ fine hand coordination Function - difficulty w/ heavy load bearing 1 Year 32 1 Year 32 Function - difficulty wringing 1 Year 32 Stochastic Randomization Allocation Concealment Patients Blinded Those rating outcome Blinded Follow Up - 80% or more All groups have similar outcome performance at entry Cast Cast Cast Cast Cast Cast Cast Cast Cast Cast Cast Crossover - equal experimental group results Crossover - equal control group results

27 Evidence Table 12 Operative vs. Non-operative Treatment of Distal Radius Fractures in Patients Over Age 55 Quality and Design of Randomized Controlled Trials = Yes = No = Not Reported n/a = not applicable Author Outcome Duration N Treatment(s) Hegeman, et al. Hegeman, et al. Hegeman, et al. Roumen, et al Roumen, et al Roumen, et al Pain, radiocarpal 1 Year 32 Pain, radioulnar 1 Year 32 Pain, ulnocarpal 1 Year 32 Pain (continuous) 26 Weeks 101 Pain (on movement) 26 Weeks 101 Pain (ulnar compression) 26 Weeks 101 Stochastic Randomization Allocation Concealment Patients Blinded Those rating outcome Blinded Follow Up - 80% or more All groups have similar outcome performance at entry Cast Cast Cast External fixation - following redisplacement vs. Cast - following redisplacement External fixation - following redisplacement vs. Cast - following redisplacement External fixation- following redisplacement vs. Cast - following redisplacement Crossover - equal experimental group results Crossover - equal control group results

28 Evidence Table 13 Operative vs. Non-operative Treatment of Distal Radius Fractures in Patients Over Age 55 Randomized Controlled Studies DATA Author Outcome Duration N Treatment(s) Operative Non-operative Azzopardi, et al. Pain - VAS 1 Year 57 Azzopardi, et al. Azzopardi, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. Hegeman, et al. : mean score 0-10 (unit of measurement not reported) SF-36 (mental) 1 Year 57 SF-36 (physical) 1 Year 57 Pain, radiocarpal 6 Weeks 32 Pain, radiocarpal 3 Months 32 Pain, radiocarpal 1 Year 32 Pain, radioulnar 6 Weeks 32 Pain, radioulnar 3 Months 32 Pain, radioulnar 1 Year 32 Pain, ulnocarpal 6 Weeks 32 Pain, ulnocarpal 3 Months 32 Pain, ulnocarpal 1 Year 32 Percutaneous pinning vs. Cast Percutaneous pinning vs. Cast Percutaneous pinning vs. Cast Cast Cast Cast Cast Cast Cast Cast Cast Cast 0.7 ± ± ± ± ± ± % (9/15 patients) 40% (6/15 patients) 13% (2/15 patients) 60% (9/15 patients) 33% (5/15 patients) 13% (2/15 patients) 60% (9/15 patients) 33% (5/15 patients) 13% (2/15 patients) 35% (6/15 patients) 29% (5/15 patients) 18% (3/15 patients) 29% (5/15 patients) 29% (5/15 patients) 18% (3/15 patients) 29% (5/15 patients) 29% (5/15 patients) 18% (3/15 patients)

29 Evidence Table 13 Operative vs. Non-operative Treatment of Distal Radius Fractures in Patients Over Age 55 Randomized Controlled Studies DATA Author Outcome Duration N Treatment(s) Operative Non-operative Hegeman, et al. Function - difficulty lifting cup 6 Weeks 32 Cast 73% (11/15 patients) 82% (14/15 patients) Hegeman, et al. Function - difficulty lifting cup 3 Months 32 Cast 53% (8/15 patients) 18% (3/15 patients) Hegeman, et al. Function - difficulty lifting cup 1 Year 32 Cast 7% (1/15 patients) 12% (2/15 patients) Hegeman, et al. Function - difficulty wringing 6 Weeks 32 Cast 87% (13/15 patients) 82% (14/15 patients) Hegeman, et al. Function - difficulty wringing 3 Months 32 Cast 87% (13/15 patients) 65% (11/15 patients) Hegeman, et al. Function - difficulty wringing 1 Year 32 Cast 53% (8/15 patients) 18% (3/15 patients) Hegeman, et al. Function - difficulty w/ fine hand coordination 6 Weeks 32 Cast 80% (12/15 patients) 82% (14/15 patients) Hegeman, et al. Function - difficulty w/ fine hand coordination 3 Months 32 Cast 67% (10/15 patients) 18% (3/15 patients) Hegeman, et al. Function - difficulty w/ fine hand coordination 1 Year 32 Cast 13% (2/15 patients) 29% (5/15 patients) Hegeman, et al. Function - difficulty w/ heavy load bearing 3 Months 32 Cast 80% (12/15 patients) 76% (13/15 patients) Hegeman, et al. Function - difficulty w/ heavy load bearing 6 Weeks 32 Cast 80% (12/15 patients) 82% (14/15 patients) Hegeman, et al. Function - difficulty w/ heavy load bearing 1 Year 32 Cast 60% (9/15 patients) 59% (10/15 patients) Roumen, et al Pain (continuous) 26 Weeks 43 External fixator vs. Cast 5% (1/21 patients) 0% (0/22 patients) Roumen, et al Pain (on movement) 26 Weeks 43 External fixator vs. Cast 10% (2/21 patients) 18% (4/22 patients) Roumen, et al Pain (ulnar compression) 26 Weeks 43 External fixator vs. Cast 29% (6/21 patients) 14% (3/22 patients)

30 Evidence Table 14 Locking Plates for Treatment of Distal Radius Fractures in Patients Over Age 55 Included and Excluded Articles Author Title Included or Reason for Exclusion Oshige, et al Chung, et al. Jakubietz, et al. A comparative study of clinical and radiological outcomes of dorsally angulated, unstable distal radius fractures in elderly patients: intrafocal pinning versus volar locking plating Comparative outcomes study using the volar locking plating system for distal radius fractures in both young adults and adults older than 60 years A randomised clinical study comparing palmar and dorsal fixed-angle plates for the internal fixation of AO C-type fractures of the distal radius in the elderly Not relevant, comparison of age groups Does not compare locking plates to other non-locking plate operative treatment Atroshi, et al Fu, et al Kamiloski, et al Hegeman, et al. Koshimune, et al. Shiota, et al Moroni, et al Trumble, et al Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: a randomized assessor-blind clinical trial of 38 patients followed for 1 year Use of an external fixation combined with the buttress-maintain pinning method in treating comminuted distal radius fractures in osteoporotic patients External fixation in patients with age over 65 years with distal radius fracture External fixation for unstable intra-articular distal radial fractures in women older than 55 years. Acceptable functional end results in the majority of the patients despite significant secondary displacement A randomized comparison of locking and non-locking palmar plating for unstable Colles' fractures in the elderly Conehead wedging screw for distal radius fractures in elderly patients Improvement of the bone-pin interface strength in osteoporotic bone with use of hydroxyapatite-coated tapered external-fixation pins. A prospective, randomized clinical study of wrist fractures Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation Does not compare locking plates to other non-locking plate operative treatment Does not report validated, patient oriented outcomes Does not report validated, patient oriented outcomes Reports complications only, < 25 patients